Organization
CENTRAL BREVARD RADIOLOGY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID J HILLEREN MD (PRESIDENT)
(321) 799-7192
Entity
Organization
Contact information
Practice address
701 W COCOA BEACH CSWY, COCOA BEACH, FL 32931-3585
(321) 799-7192
(770) 237-4866
Mailing address
PO BOX 881839, PORT ST LUCIE, FL 34988-1839
(727) 896-3134
(770) 621-3181
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
—
—
2085N0904X
Nuclear Radiology Physician
—
—
2085P0229X
Pediatric Radiology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
2085U0001X
Diagnostic Ultrasound Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
058771100
—
FL
01
—
39812
BLUE CROSS BLUE SHIELD
FL
01
—
CA4481
RR MEDICARE
FL
Enumeration date
08/29/2006
Last updated
02/09/2012
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